Assessment of the arteriovenous cerebrovascular system by multi-slice CT: A single-bolus, monophasic protocol

Purpose: We present a protocol for the non-invasive angiographic assessment of the arterial and venous cerebrovascular (CV) system by multi-slice CT.

Material and Methods: Data acquisition was performed in a multi-slice CT scanner with a scan range from the carotid bifurcation to the vertex and manual scan start following i.v. administration of 120 ml iodinated contrast medium with a flow rate of 4 ml/s. This protocol was applied in 12 patients with symptoms of acute CV insuffiency.

Results: In all patients, comprehensive imaging of the arteriovenous CV system was achieved including the common carotid bifurcation, the third segment of the major cerebral arteries, the dural sinus and the internal cerebral veins. Various CV pathologies, such as a territorial artery occlusion, a thrombotic obstruction of the internal carotid artery, an intracranial arteriovenous malformation and a sinus vein thrombosis, were successfully evaluated.

Conclusion: Comprehensive assessment of the arteriovenous CV system is possible by the use of a single-bolus, monophasic multi-slice scan technique.

Physico-chemical characterisation of material fractions in residual and source-segregated household waste in Denmark

Physico-chemical waste composition data are paramount for the assessment and planning of waste management systems. However, the applicability of data is limited by the regional, temporal and technical scope of waste characterisation studies. As Danish and European legislation aims for higher recycling rates evaluation of source-segregation and recycling chains gain importance. This paper provides a consistent up-to-date dataset for 74 physico-chemical parameters in 49 material fractions from residual and 24 material fractions from source-segregated Danish household waste. Significant differences in the physico-chemical properties of residual and source-segregated waste fractions were found for many parameters related to organic matter, but also for elements of environmental concern. Considerable differences in potentially toxic metal concentrations between the individual recyclable fractions within one material type were observed. This indicates that careful planning and performance evaluation of recycling schemes are important to ensure a high quality of collected recyclables. Rare earth elements (REE) were quantified in all waste fractions analysed, with the highest concentrations of REE found in fractions with high content of mineral raw materials, soil materials and dust. The observed REE concentrations represent the background concentration level in non-hazardous waste materials that may serve as a reference point for future investigations related to hazardous waste management. The detailed dataset provided here can be used for assessments of waste management solutions in Denmark and for the evaluation of the quality of recyclable materials in waste.

Von der Risiko- zur Anbieterselektion

Seit den 1990er Jahren lässt sich in mehreren OECD-Gesundheitssystemen des Sozialversicherungstyps die Implementation wettbewerblicher Reformen beobachten. Ein Vergleich von Deutschland und den Niederlanden als zwei Vertretern dieses Typs zeigt, dass diese Reformen eine Eigendynamik entwickeln: Einmal in einem Teilsegment eingeführter Wettbewerb erfordert „mehr“ Wettbewerb und Re-Regulierung. Von der freien Kassenwahl gingen in beiden Staaten zunächst steigende Anreise zur Risikoselektion aus. Um dieser Fehlentwicklung Einhalt gebieten, verbesserte der Gesetzgeber die Risikoadjustierung und eröffnete Möglichkeiten zur Anbieterselektion. Als Konsequenz wird das korporatistische Steuerungsmodell sukzessive durch Marktwettbewerb und staatliche Hierarchie ergänzt oder sogar substituiert.

Quantification of chemical contaminants in the paper and board fractions of municipal solid waste

Chemicals are used in materials as additives in order to improve the performance of the material or the production process itself. The presence of these chemicals in recyclable waste materials may potentially affect the recyclability of the materials. The addition of chemicals may vary depending on the production technology or the potential end-use of the material. Paper has been previously shown to potentially contain a large variety of chemicals. Quantitative data on the presence of chemicals in paper are necessary for appropriate waste paper management, including the recycling and re-processing of paper. However, a lack of quantitative data on the presence of chemicals in paper is evident in the literature. The aim of the present work is to quantify the presence of selected chemicals in waste paper derived from households. Samples of paper and board were collected from Danish households, including both residual and source-segregated materials, which were disposed of (e.g., through incineration) and recycled, respectively. The concentration of selected chemicals was quantified for all of the samples. The quantified chemicals included mineral oil hydrocarbons, phthalates, phenols, polychlorinated biphenyls, and selected toxic metals (Cd, Co, Cr, Cu, Ni, and Pb). The results suggest large variations in the concentration of chemicals depending on the waste paper fraction analysed. Research on the fate of chemicals in waste recycling and potential problem mitigation measures should be focused on in further studies.

[Market Concentration in the Statutory Health Insurance of Germany since the Introduction of Free Choice of Sickness Funds]

Background: The expansion of trust law to the German statutory health insurance (SHI) and the declining numbers of sickness funds suggest a strong concentration process in the German SHI market. The paper examines the level and development of market concentration since the introduction of the free choice of sickness funds in 1996. Data: The study is based on a dataset containing information on membership, contribution rate, openness, area of activity and legal successor for all sickness funds in the period from 1996 to 2013. Methods: Market concentration is measured by the concentration rate (cumulative market share of the largest market participants) and the Herfindahl-Hirschman index (HHI). In addition, the change in the HHI is also disaggregated into 3 factors: opening, switching and fusion of sickness funds. Results: Concentration rate and HHI decreased significantly between 1996 and 2008 due to opening of former closed sickness funds and a switching behaviour from large to small funds. The SHI Competition Enhancement Act of 2007 led to a turnaround. The reform permitted cross-type mergers and introduced a completely new system of budget allocation with the central health fund. The latter put an end to the growing membership of small funds due to adverse selection processes. As a result, market concentration in the German SHI rises. Although recent mega-mergers were uncritical for nationwide competition, the study already indicates the risk of market dominance on the regional level.

Five types of OECD healthcare systems: empirical results of a deductive classification

This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using OECD Health Data and WHO country reports. The classification results in five system types: the National Health Service, the National Health Insurance, the Social Health Insurance, the Etatist Social Health Insurance, and the Private Health System. All five types belong to the group of healthcare system types considered theoretically plausible. Merely Slovenia does not comply with our assumption of a hierarchy among dimensions and typical actors due to its singular transformation history.

Explaining health care system change: problem pressure and the emergence of "hybrid" health care systems

In this article, we will further the explanation of the state's changing role in health care systems belonging to the Organisation for Economic Cooperation and Development (OECD). We build on our analysis of twenty-three OECD countries, which reveals broad trends regarding governments' role in financing, service provision, and regulation. In particular, we identified increasing similarities between the three system types we delineate as National Health Service (NHS), social health insurance, and private health insurance systems. We argue that the specific health care system type is an essential contributor to these changes. We highlight that health care systems tend to feature specific, type-related deficiencies, which cannot be solved by routine mechanisms. As a consequence, non-system-specific elements and innovative policies are implemented, which leads to the emergence of "hybrid" systems and indicates a trend toward convergence, or increasing similarities. We elaborate this hypothesis in two steps. First, we describe system-specific deficits of each health care system type and provide an overview of major adaptive responses to these deficits. The adaptive responses can be considered as non-system-specific interventions that broaden the portfolio of regulatory policies. Second, we examine diagnosis-related groups (DRGs) as a common approach for financing hospitals efficiently, which are nevertheless shaped by type-specific deficiencies and reform requirements. In the United States' private insurance system, DRGs are mainly used as a means of hierarchical cost control, while their implementation in the English NHS system is to increase productivity of hospital services. In the German social health insurance system, DRGs support competition as a means to control self-regulated providers. Thus, DRGs contribute to the hybridization of health care systems because they tend to strengthen coordination mechanisms that were less developed in the existing health care systems.